File:Pathology and treatment of diseases of women (1912) (14595070298).jpg

Identifier: pathologytreatme00mart (find matches)
Title: Pathology and treatment of diseases of women
Year: 1912 (1910s)
Authors: Martin, August Eduard, 1847- Jung, Ph. (Philipp Jacob), 1870-1918
Subjects: Gynecology Gynecology
Publisher: New York : Rebman company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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carcinomatous or sarcomatous tumors necessitate an immedi-ate extirpation also of the uterus. The majority of gynecologists, at present, condemn the attempt at anexploratory puncture if a radical operation does not immediately followit. Even then it appears admissible only after an exposure by an ab-dominal incision, because not only the escape of fluid into the abdominalcavity through the puncture wound must be feared, but still more thedisplacement of tissue, which may lead to a metastasis. Ovariotomy is at present universally executed by ligating the pedi-cle and after removal of the tumor the cut surface of the pedicle is THE DISEASES OF THE OVARIES 411 covered with peritoneum over the ligature. The delivery of the tumoruntil the pedicle is accessible may be undertaken through the incisedabdominal wall (abdominal) or through the vagina (vaginal). The vaginal route is reserved for the less voluminous tumors, espe-cially if they are movable, and therefore adhesions presumably do not
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Fig. 182.—Abdominal Ovariotomy. The uterus has emerged with the cystoma out ofthe abdominal incision. Ligature of the pedicle in four parts. exist. Finally, somewhat more voluminous cystomata, even if theyhave already ascended out of the pelvis, may very well be removed pervaginam. Abdominal Ovariotomy.—Large tumors and those in which adhe-:sions cannot safely be excluded are preferably attacked through an inci- 412 DISEASES OF WOMEN sion of the abdominal wall. It rests with the operator to make a medianline or a transverse incision. Moderately sized tumors are deliveredalways undiminished in size, by inserting the hand underneath them andat the same time examining the condition of the pedicle. In very largetumors one has the choice either of enlarging the abdominal incision untilthe entire tumor can pass through, or of diminishing the latter. I amalways influenced by the conditions present. The surroundings are care-fully protected by lap sponges before the delivery or diminution

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